38 Chapter 2 Clinical factors independently related to a prolonged length of stay at the ED All clinical factors (i.e., presenting complaint, diagnosis at the ED visit, and the treating specialty) were significantly related to a prolonged ED LOS (all p < 0.001; table 4). In multivariable analysis; presenting complaint of a neurological (OR 2.2, CI 1.0-4.5) or internal medicine focus (OR 2.6, CI 1.4-4.6) had a higher likelihood of a prolonged LOS at the ED when compared to older patients with a presenting complaint of trauma. Older patients, presenting at the ED, with an altered consciousness, also had a higher likelihood of a prolonged LOS at the ED (OR 3.3, CI 1.6-6.6) (table 5). When compared to patients treated by an emergency physician, patients treated by physicians of the departments of surgery (OR 3.4, CI 2.2-5.2), internal medicine (OR2.6, CI 1.9-3.7), orpulmonology (OR2.2, CI 1.4-3.6) hada significantly prolonged LOS at the ED (table 5). However, we should take into account that the group of patients treated by the emergency physician contained patients with less comorbidity: 91% of all patients treated by the emergency physicians had a CACI score of 3-7. In contrast, 80 % of patients treated by doctors of other medical departments, had a CACI score of 3-7. When compared to doctors of other medical departments, emergency physicians less often treated patients with higher CACI scores ranging from 8 – 11 (8.9% vs. 19%) and scores ranging from 12 – 14 (0 vs. 1.4%; P < 0.001). Discussion In this study we identified several risk factors for a prolonged LOS of older patients at the ED. We found that older patients with presenting complaints of a neurological or internal medicine focus had a higher likelihood of a prolonged LOS at the ED. Patients with an altered consciousness, higher number of consultations and higher number of diagnostic interventions also had a higher likelihood of prolonged LOS at the ED. Treatment of older patients by physicians of the departments of surgery, internal medicine or pulmonology were more likely to result in prolonged LOS at the ED. The association of presenting complaints with prolonged LOS at the ED has been studied in different patient populations [10], but there is little published data on this association specifically in the subgroup of older patients. A recent study that examined this association among older patients [7], did not find an association between complaints at presentation and LOS of older patients at the ED, which is in contrast with our findings. The difference in findings may be explained by the fact that we included complaints related to all medical fields,
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